Final Report (all chapters)

episode. Reputational incentives are an effective sanctioning mechanism only when highly
visible controversies erupt. As mentioned earlier, innovative reproductive treatments generally
are conducted discreetly; the news media, regulators, and the public learn about these
experiments only sporadically, and sometimes not at all. In this sense, the role of reputational
incentives as an effective sanctioning mechanism must be regarded as quite limited.
4.4 Reproductive Customization Technologies
While the reproductive technologies discussed so far were initially developed exclusively
for therapeutic reasons, in this section we turn to ART treatments that are not designed to treat a
physiological condition, though they do have some specific medical applications. The primary
use of these reproductive technologies is simply the accommodation of parental wishes of one
kind or another. In this sense, these are reproductive customization technologies rather than
reproductive treatments, in the narrow sense of this term. They are intended to provide
prospective parents with the means to exercise control over the reproductive process rather than
simply to help them conceive.
With this type of technology, we enter into one of the most controversial areas of
reproductive medicine. Unlike innovative reproductive treatments – where the technical means
may be controversial but the goal served (procreation) remains the same – in the present case we
are dealing with technologies that are beginning to redefine the very meaning and nature of
procreation. They do so not in a dramatic or spectacular way, to be sure. Some uses of these
technologies, considered in isolation, could even be described as prosaic. From a pragmatic
perspective, it is difficult to quarrel with a mother who, after having three boys, wishes to have a
girl. But, as is so often the case in the field of artificial reproduction, things are not quite so
simple. Many people feel uncomfortable with suggestions that conception could be customized,
though they may not be able to articulate the precise reasons for their discomfort. Others, fearing
the degradation of human reproduction to a commercial transaction, will find any technology of
customization altogether unacceptable. Still others take the opposite stance, advocating freedom
of choice in matters considered purely private. 38
An obvious example of the non-therapeutic use of a reproductive technology is elective sex
selection. Currently, two options exist to choose the sex of a child – pre-implantation genetic
diagnosis and MicroSort ® . While MicroSort is still being tested, PGD is already available.
Reliable data is hard to come by, but according to industry insiders, PGD is rapidly gaining
popularity as a sex-selection technology. Another example of a reproductive technology’s nontherapeutic
use is genetic engineering, i.e., germ-line genetic modification. Human genetic
engineering, just a few years ago derided by many scientists as en entirely speculative and utterly
irrelevant scenario, is becoming a reality much more rapidly than was initially anticipated, as a
38
In this regard, some of the ethical principles introduced in chapter 3 – such as privileging therapeutic over
enhancing uses of reproductive technologies and protecting the health and well-being of children, but also
promoting access to reproductive technologies – may be able to structure these controversies.
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